In our ongoing exploration of the Phoenix abortion and the application of double effect, commenter Marle asks a great clarifying question:
Dr Nadal, I understand I will never get you to agree with abortion and I’m not trying to convince you otherwise. What I don’t understand about double effect is why abortion is ok if you take the fallopian tube. The fallopian tube isn’t killing a woman in that situation; as evidenced by the fact that in many cases the fallopian tube doesn’t have to be removed. What’s killing the woman in a tubal pregnancy is a fetus growing where it can’t, and it has to be removed. It seems to me that double effect makes it so that abortion is ok as long as the woman is permanently hurt in the process.
Gerard M. Nadal
I don’t think that either of us is convert hunting here. One of the purposes for which this blog is offered is to have a quiet little corner for people to duck in from the maelstrom and explore some of the science, ethics and theology that undergird the pro-life movement. I prefer a quiet and civil, academic tone to the screaming out of the windows at passers-by found elsewhere, and thank you for such a reserved tone.
Let’s walk this through slowly and deliberately to best answer your question.
First and foremost, the difficulty in discussing double-effect (DE from here) is magnified if one of the parties sees no problem with abortion in general. DE seems a sleight of hand at abortion to most pro-choice folks with whom I have spoken.
However, to understand DE, we must assume a starting position that states a categorical prohibition of the direct targeting of the baby (more properly embryo or fetus) for death. In a word: Abortion.
There is a huge difference between an abortion and removal of a fallopian tube containing an embryo, or a hysterectomy of a severely cancerous uterus containing an embryo or fetus. That difference is what DE establishes. To recapitulate the four conditions which establish DE:
First: The action contemplated must be in itself either morally good or morally indifferent.
Second: The bad result must not be directly intended.
Third: The good result must flow from the action as immediately as the bad effect.
Fourth: The good result must be “proportionate to” the bad result.
It must be stressed that all four of these conditions MUST be met for DE to have been established.
Let’s start with an advanced tubal pregnancy first. The embryo has gotten stuck (usually behind a blockage in the tube such as scar tissue from PID). The embryo continues to develop to the point of swelling the tube and eventually bursting it with catastrophic hemorrhaging by the mother. It can be, and is for too many, immediately fatal.
The removal of the tube satisfies the above 4 conditions as follows:
1. The action being contemplated here is not the killing of the baby, but the removal of a tube that is a clear and present danger to the mother’s life. The removal of the dangerously damaged tube is itself a moral good.
2. There is a bad effect in the removal of the tube. There is a baby inside that is going to die when we remove the tube. Current medical science has no way of extracting the baby and implanting it in the uterus. Nevertheless, a bad result will ensue. A baby will die. This result, however, is not directly intended. Intent matters greatly.
3. The good result is that the mother’s life has been saved. The bad result is that the baby died. The benefit to the mother is as immediate as the bad effect because the dangerously damaged tube has been removed.
4. The good result is proportionate to the bad result in that we saved the life of the mother, though unintentionally the baby died
So we see that the removal of an advanced tubal pregnancy satisfies all four conditions for DE.
In the case of an early tubal pregnancy treated with methotrexate, none of the conditions of DE applies.
1. The contemplated action itself is morally bad: the chemical abortion of the embryo.
2. The bad result (death of the baby) is directly intended.
3. The good result does not flow immediately from the action along with the bad effect. (There is no guarantee that the tube will be useful in the future, especially if scarred from PID).
4. The good result (saving a fallopian tube) is disproportionate to the loss of baby’s life (even if the loss were a certainty in advanced tubal pregnancy).
In short, as methotrexate targets the baby directly, it is nothing more than a chemical abortion. There have been reports of early tubal pregnancies where the embryo has dislodged itself. The child deserves the chance, as well as the medical community exploring ways to safely secure that result through medical intervention.
Thus we see through the conditions for establishing DE that certain life-saving procedures may be performed if the direct action is morally good, the bad action is not directly willed or intended, the good action flows as immediately as the bad action, and the good result is proportionate to the bad result.